COVID-19 At-Home Self-Screening Questionnaire

  • Have you experienced any of the following symptoms in the past 48 hours:

    • fever or chills

    • cough

    • shortness of breath or difficulty breathing

    • muscle or body aches

    • new loss of taste or smell

    • sore throat

    • congestion or runny nose

  • Within the past 14 days, have you been in close physical contact with a person who is known to have laboratory-confirmed COVID-19 or with anyone who has any symptoms consistent with COVID-19? Close contact is being withing 6 feet for 15 minutes or more over a 24-hour period with a person; or having direct contact with fluids from a person with COVID-19 with or without wearing a mask (i.e., being coughed or sneezed on).

  • Are you isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?

  • Have you had a positive COVID-19 test for active virus in the past 10 days, or are you currently waiting on the results of a COVID-19 test?

Covid-19 Screening

If you, the field technician, answers NO to every question in the COVID-19 Screening Questionnaire, the company assumes that you are fit for work, have nothing to report, and are available to work your shift that day.